In psychology, a somatoform disorder is a mental disorder characterized by physical symptoms that suggest physical illness or injury – symptoms that cannot be explained fully by a general medical condition, direct effect of a substance, or attributable to another mental disorder (e.g. panic disorder). The symptoms that result from a somatoform disorder are due to mental factors. In people who have a somatoform disorder, medical test results are either normal or do not explain the person’s symptoms. Patients with this disorder often become worried about their health because the doctors are unable to find a cause for their health problems. Symptoms are sometimes similar to those of other illnesses and may last for several years.
Somatoform disorders are not the result of conscious malingering (fabricating or exaggerating symptoms for secondary motives) or factitious disorders (deliberately producing, feigning, or exaggerating symptoms) – sufferers perceive their plight as real. Additionally, a somatoform disorder should not be confused with the more specific diagnosis of a somatization disorder.
Disorders in this Category
- Body Dysmorphic Disorder
- Conversion Disorder
- Hypochondriasis Disorder
- Pain Disorder
- Somatization Disorder
Body dysmorphic disorder (BDD) (previously known as dysmorphophobia is sometimes referred to as body dysmorphia or dysmorphic syndrome) is a (psychological) somatoform disorder in which the affected person is excessively concerned about and preoccupied by a perceived defect in his or her physical features (body image).
The sufferer may complain of several specific features or a single feature, or a vague feature or general appearance, causing psychological distress that impairs occupational and/or social functioning, sometimes to the point of severe depression and anxiety, development of other anxiety disorders, social withdrawal or complete social isolation, and more. It is estimated that 1–2% of the world’s population meet all the diagnostic criteria for BDD (Psychological Medicine, vol. 36, p. 877).
The exact cause(s) of BDD differ(s) from person to person. However, most clinicians believe it could be a combination of biological,psychological, and environmental factors from their past or present. Abuse and neglect can also be contributing factors.
Onset of symptoms generally occurs in adolescence or early adulthood, where most personal criticism of one’s own appearance usually begins, although cases of BDD onset in children and older adults are not unknown. BDD is often misunderstood to affect mostly women, but research shows that it affects men and women equally.
The disorder is linked to significantly diminished quality of life and can be co-morbid with major depressive disorder and social phobia, also known as chronic social anxiety. With a completed-suicide rate more than double that of major depression (three to four times that of manic depression) and a suicidal ideation rate of around 80%, extreme cases of BDD linked with dissociation can be considered a risk factor for suicide; however, many cases of BDD are treated with medication and counseling.
A person with the disorder may be treated with psychotherapy, medication, or both. Research has shown cognitive behavioural therapy (CBT) and selective serotonin reuptake inhibitors(SSRIs) to be effective in treating BDD.
BDD is a chronic illness, and symptoms are likely to persist, or worsen, if left untreated.Learn More
Conversion disorder is a condition in which patients present with neurological symptoms such as numbness, blindness, paralysis, or fitswithout a neurological cause. It is thought that these problems arise in response to difficulties in the patient’s life, and conversion is considered a psychiatric disorder in the Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV). Formerly known as “hysteria”, the disorder has arguably been known for millennia, though it came to greatest prominence at the end of the 19th century, when the neurologists Jean-Martin Charcot and Sigmund Freud and psychiatrist Pierre Janet focused their studies on the subject. The term “conversion” has its origins in Freud’s doctrine that anxiety is “converted” into physical symptoms. Though previously thought to have vanished from the west in the 20th century, some research has suggested it is as common as ever.
DSM-IV defines conversion disorder as follows:
- One or more symptoms or deficits are present that affect voluntary motor or sensory function suggestive of a neurologic or other general medical condition.
- Psychological factors are judged, in the clinician’s belief, to be associated with the symptom or deficit because conflicts or other stressors precede the initiation or exacerbation of the symptom or deficit. A diagnosis where the stressor precedes the onset of symptoms by up to 15 years is not unusual.
- The symptom or deficit is not intentionally produced or feigned (as in factitious disorder or malingering).
- The symptom or deficit, after appropriate investigation, cannot be explained fully by a general medical condition, the direct effects of a substance, or as a culturally sanctioned behavior or experience.
- The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.
- The symptom or deficit is not limited to pain or sexual dysfunction, does not occur exclusively during the course of somatization disorder, and is not better accounted for by anothermental disorder.
Pain disorder is when a patient experiences chronic pain in one or more areas, and is thought to be caused by psychological stress. The pain is often so severe that it disables the patient from proper functioning. Duration may be as short as a few days or as long as many years. The disorder may begin at any age, and more women than men seem to experience it. This disorder often occurs after an accident or during an illness that has caused pain, which then takes on a ‘life’ of its own.Learn More
Somatization disorder (also Briquet’s disorder or, in antiquity, hysteria) is a psychiatric diagnosis applied to patients who persistently complain of varied physical symptoms that have no identifiable physical origin. The disorder must begin before the patient turns 30 years of age and could last for several years, resulting to either medical seeking behavior or significant treatment. One common generaletiological explanation is that internal psychological conflicts are unconsciously expressed as physical signs. Patients with somatization disorder will typically visit many doctors in pursuit of effective treatment.
Examples of manifestations of Pychosomatic disorder are as such: a child itches in response to family issues, and experiencing repressed anger and/or fear. Thus, The child grows and wakes up itching in the same locations, though not aware of the repressed memory causing the suffering in later life, or the patient is engaged in seeking psychotherapy for somatization.
Somatization disorder is a somatoform disorder. The DSM-IV establishes the following five criteria for the diagnosis of this disorder:
- a history of somatic symptoms prior to the age of 30
- pain in at least four different sites on the body
- two gastrointestinal problems other than pain such as vomiting or diarrhea
- one sexual symptom such as lack of interest or erectile dysfunction
- one pseudoneurological symptom similar to those seen in Conversion disorder such as fainting or blindness.
A substance-related disorder is an umbrella term used to describe several different conditions (such as intoxication, harmful use/abuse, dependence, withdrawal, and psychoses or amnesia associated with the use of the substance) associated with several different substances (such as alcohol or opiods).
Substance-related disorders can be subcategorized into “substance use disorders” (SUD) and “substance-induced disorders” (SID).
Though DSM-IV makes a firm distinction between the two, SIDs often occur in the context of SUDs.
Disorders in this CategoryLearn More
Female sexual arousal disorder (FSAD), commonly referred to as frigidity, is a disorder characterized by a persistent or recurrent inability to attain sexual arousal or to maintain arousal until the completion of a sexual activity, or an adequate lubrication-swelling response that otherwise is present during arousal and sexual activity. The condition should be distinguished from a general loss of interest in sexual activity and from other sexual dysfunctions, such as the orgasmic disorder (anorgasmia) and hypoactive sexual desire disorder, which is characterized as a lack or absence of sexual fantasies and desire for sexual activity for some period of time.
Although female sexual dysfunction is currently a contested diagnostic, pharmaceutical companies are beginning to promote products to treat FSD, often involving low doses of testosterone.Learn More
Gender identity disorder (GID) is the formal diagnosis used by psychologists and physicians to describe persons who experience significant gender dysphoria (discontent with their biological sex and/or the gender they were assigned at birth). It describes the symptoms related to transsexualism, as well as less severe manifestations of gender dysphoria.
Gender identity disorder in children is usually reported as “having always been there” since childhood, and is considered clinically distinct from GID that appears in adolescence or adulthood, which has been reported by some as intensifying over time. As gender identity develops in children, so do sex-role stereotypes. Sex-role stereotypes are the beliefs, characteristics and behaviors of individual cultures that are deemed normal and appropriate for boys and girls to possess. These “norms” are influenced by family and friends, the mass-media, community and other socializing agents. Since many cultures strongly disapprove of cross-gender behavior, it often results in significant problems for affected persons and those in close relationships with them. In many cases, transgendered individuals report discomfort stemming from the feeling that their bodies are “wrong” or meant to be different.
Many transgendered people and researchers support the declassification of GID as a mental disorder for several reasons. Recent medical research on the brain structures of transgendered individuals have shown that some transgendered individuals have the physical brain structures that resemble their desired sex even before hormone treatment. In addition, recent studies are indicating more possible causes for gender dysphoria, stemming from genetic reasons and prenatal exposure to hormones, as well as other psychological and behavioral reasons.
One contemporary treatment for this disorder consists primarily of physical modifications to bring the body into harmony with one’s perception of mental (psychological, emotional) gender identity, rather than vice versa.Learn More
Borderline personality disorder (BPD) is a personality disorder described as a prolonged disturbance of personality function in a person (generally over the age of eighteen years, although it is also found in adolescents), characterized by depth and variability of moods. The disorder typically involves unusual levels of instability in mood; black and white thinking, or splitting; the disorder often manifests itself inidealization and devaluation episodes, as well as chaotic and unstable interpersonal relationships, self-image, identity, and behavior; as well as a disturbance in the individual’s sense of self. In extreme cases, this disturbance in the sense of self can lead to periods of dissociation.
BPD splitting includes a switch between idealizing and demonizing others. This, combined with mood disturbances, can undermine relationships with family, friends, and co-workers. BPD disturbances also may include self-harm. Without treatment, symptoms may worsen, leading (in extreme cases) to suicide attempts.
There is an ongoing debate among clinicians and patients worldwide about terminology and the use of the word borderline, and some have suggested that this disorder should be renamed. The ICD-10 manual has an alternative definition and terminology to this disorder, calledEmotionally unstable personality disorder. There is related concern that the diagnosis of BPD stigmatizes people and supports pejorative and discriminatory practices.Learn More
Sexual dysfunction or sexual malfunction refers to a difficulty experienced by an individual or a couple during any stage of a normal sexual activity, including desire, arousal or orgasm.
To maximize the benefits of medications and behavioural techniques in the management of sexual dysfunction it is important to have a comprehensive approach to the problem, A thorough sexual history and assessment of general health and other sexual problems (if any) are very important. Assessing (performance) anxiety, guilt (associated with masturbation in many Indian men), stress and worry are integral to the optimal management of sexual dysfunction. When a sexual problem is managed inappropriately or sub-optimally, it is very likely that the condition will subside immediately but re-emerge after a while. When this cycle continues, it strongly reinforces failure that eventually make clients not to access any help and suffer it all their life. So, it is important to get a thorough assessment from professionals and therapists who are qualified to manage sexual problems. Internet-based information is good for gaining knowledge about sexual functioning and sexual problem but not for self-diagnosis and/or self-management.
Disorders in this Category
Dysfunctions in this Category
- Female Orgasmic Disorder
- Female Sexual Arousal Disorder
- Gender Identity Disorder
- Hypoactive Sexual Desire Disorder
- Erectile Dysfunction
- Orgasmic Disorder (Anorgasmia)
- Premature Ejaculation
- Hypoactive Sexual Desire Disorder
In clinical psychology, voyeurism is the sexual interest in or practice of spying on people engaged in intimate behaviors, such as undressing, sexual activity, or other activity usually considered to be of a private nature.
Voyeurism (from the French voyeur, “one who looks”) can take several forms, but its principal characteristic is that the voyeur does not normally relate directly with the subject of their interest, who is often unaware of being observed. The practice of making a permanent image of an intimate activity has been made easier with modern photographic and video technology, and is considered an invasion of privacy. However, in today’s society the concept of voyeurism has evolved, especially in popular culture. Non-pornographic reality television programs such as Survivor and The Real World, are prime examples of voyeurism, where viewers (the voyeur) are granted an intimate interaction with a subject group or individual. Although not necessarily “voyeurism” in its original definition, as individuals in these given situations are aware of their audience, the concept behind “reality TV” is to allow unscripted social interaction with limited outside interference or influence. As such, the term still maintains its sexual connotations.Learn More
Brief psychotic disorder is a period of psychosis whose duration is generally shorter, non re-occurring, and not better accounted for by another condition.
The disorder is characterized by a sudden onset of psychotic symptoms, which may include delusions, hallucinations, disorganized speech or behavior, or catatonic behavior. The symptoms must not be better accounted for by schizophrenia, schizoaffective disorder, delusional disorderor mania in bipolar disorder. They must also not be caused by a drug (such as amphetamines) or medical condition (such as a brain tumor).
Symptoms generally last at least a day, but not more than a month, and there is an eventual return to full baseline functioning. It may occur in response to a significant stressor in a person’s life, or in other situations where a stressor is not apparent, including in the weeks following birth. In diagnosis, a careful distinction is considered for culturally appropriate behaviors, such as religious beliefs and activities. It is believed to be connected to or synonymous with a variety of culture-specific phenomena such as latah, koro, and amokLearn More
Sexual fetishism, or erotic fetishism, is the sexual arousal a person receives from a physical object, or from a specific situation. The object or situation of interest is called the fetish, the person a fetishist who has a fetish for that object/situation. Sexual fetishism may be regarded, e.g. in psychiatric medicine, as a disorder of sexual preference or as an enhancing element to a relationship causing a better sexual bond between the partners. Arousal from a particular body part is classified as partialism.Learn More
Kleptomania is an irresistible urge to steal items of trivial value. People with this disorder are compelled to steal things, generally, but not limited to, objects of little or no significant value, such as pens, paper clips, paper and tape. Some kleptomaniacs may not even be aware that they have committed the theft.
Kleptomania was first officially recognized in the US as a mental disorder in the 1960s in the case of State of California v. Douglas Jones.
Kleptomania is distinguished from shoplifting or ordinary theft, as shoplifters and thieves generally steal for monetary value, or associated gains and usually display intent or premeditation, while kleptomaniacs are not necessarily contemplating the value of the items they steal or even the theft until they are compelled without motive.
Increasing brain research and clinical work indicate that shoplifting and stealing can become addictive-compulsive disorders. Hence, the terms “shoplifting addiction” or “theft addiction” or “compulsive theft or stealing” have gained popularity and credence recently. There even are books and support groups devoted to recovery from addictive-compulsive shoplifting or stealing. Most “theft addicts” are neither kleptomaniacs nor typical criminals who steal for profit or due to sociopathic or characterological issues.
This disorder usually manifests during puberty and, in some cases, may last throughout the person’s life.
People with this disorder are likely to have a comorbid condition, specifically paranoid, schizoid or borderline personality disorder. Kleptomania can occur after traumatic brain injuryand/or carbon monoxide poisoning.
Kleptomania is usually thought of as part of the obsessive-compulsive disorder spectrum, although emerging evidence suggests that it may be more similar to addictive and mood disorders. In particular, this disorder is frequently co-morbid with substance use disorders, and it is common for individuals with kleptomania to have first-degree relatives who suffer from a substance use disorder.
Relationship to OCD
Kleptomania is frequently thought of as being a part of obsessive-compulsive disorder, since the irresistible and uncontrollable actions are similar to the frequently excessive, unnecessary and unwanted rituals of OCD. Some individuals with kleptomania demonstrate hoarding symptoms that resemble those with OCD.
Prevalence rates between the two disorders do not demonstrate a strong relationship. Studies examining the comorbidity of OCD in subjects with kleptomania have inconsistent results, with some showing a relatively high co-occurrence (45%-60%) while others demonstrate low rates (0%-6.5%). Similarly, when rates of kleptomania have been examined in subjects with OCD, a relatively low co-occurrence was found (2.2%-5.9%).Learn More
A fugue state, formally dissociative fugue or psychogenic fugue (DSM-IV Dissociative Disorders 300.13), is a rare psychiatric disorder characterized by reversible amnesia for personal identity, including the memories, personality and other identifying characteristics of individuality. The state is usually short-lived (hours to days), but can last months or longer. Dissociative fugue usually involves unplanned travel or wandering, and is sometimes accompanied by the establishment of a new identity. After recovery from fugue, previous memories usually return intact, but there is complete amnesia for the fugue episode. Additionally, an episode is characterized as a fugue if it can be related to the ingestion of psychotropic substances, to physical trauma, to a general medical condition, or to psychiatric conditions such as delirium, dementia, bipolar disorder or depression. Fugues are usually precipitated by a stressful episode, and upon recovery there may be amnesia for the original stressor (Dissociative Amnesia).Learn More
Psychogenic amnesia, also known as functional amnesia or dissociative amnesia, is a memory disorder characterized by extreme memory loss that is caused by extensive psychological stress and that cannot be attributed to a known neurobiological cause. Psychogenic amnesia is defined by (a) the presence of retrograde amnesia (the inability to retrieve stored memories leading up to the onset of amnesia), and (b) an absence of anterograde amnesia (the inability to form new long term memories). Dissociative amnesia is due to psychological rather than physiological causes and can sometimes be helped by therapy.
There are two types of psychogenic amnesia, global and situation-specific. Global amnesia, also known as fugue state, refers to a sudden loss of personal identity that lasts a few hours to days, and is typically preceded by severe stress and/or depressed mood. Fugue state is very rare, and usually resolves over time, often helped by therapy. In most cases, patients lose their autobiographical memory and personal identity even though they are able to learn new information and perform everyday functions normally. Other times, there may be a loss of basic semantic knowledge and procedural skills such as reading and writing. Situation-specific amnesia occurs as a result of a severely stressful event, as in post-traumatic stress disorder, child sex abuse, military combat or witnessing a family member’s murder or suicide, and is somewhat common in cases of severe and/or repeated trauma.Learn More
Agoraphobia Without a History of Panic Disorder is an anxiety disorder characterized by extreme fear of experiencing panic symptoms, of panic attacks.
Agoraphobia typically develops as a result of having panic disorder. In a small minority of cases, however, agoraphobia can develop by itself without being triggered by the onset of panic attacks. Historically, there has been debate over whether Agoraphobia Without Panic genuinely existed, or whether it was simply a manifestation of other disorders such as Panic Disorder, General anxiety disorder, Avoidant personality disorder and Social Phobia. Said one researcher: “out of 41 agoraphobics seen (at a clinic) during a period of 1 year, only 1 fit the diagnosis of agoraphobia without panic attacks, and even this particular classification was questionable…Do not expect to see too many agoraphobics without panic” (Barlow & Waddell, 1985) . In spite of this earlier skepticism, current thinking is that Agoraphobia Without Panic Disorder is indeed a valid, unique illness which has gone largely unnoticed, since its sufferers are far less likely to seek clinical treatment.Learn More
Not to be confused with agraphobia, agoraphobia is a condition where the sufferer becomes anxious in environments that are unfamiliar or where he or she perceives that they have little control. Triggers for this anxiety may include wide open spaces, crowds (social anxiety), or traveling (even short distances). Agoraphobia is often, but not always, compounded by a fear of social embarrassment, as the agoraphobic fears the onset of a panic attack and appearing distraught in public. This is also sometimes called ‘social agoraphobia’ which may be a type of social anxiety disorder also sometimes called “social phobia”.
Not all agoraphobia is social in nature, however. Some agoraphobics have a fear of open spaces. Agoraphobia is also a defined as “a fear, sometimes terrifying, by those who have experienced one or more panic attacks”. In these cases, the sufferer is fearful of a particular place because they have experienced a panic attack at the same location in a previous time. Fearing the onset of another panic attack, the sufferer is fearful or even avoids the location. Some refuse to leave their home even in medical emergencies because the fear of being outside of their comfort area is too great.
The sufferer can sometimes go to great lengths to avoid the locations where they have experienced the onset of a panic attack. Agoraphobia, as described in this manner, is actually a symptom professionals check for when making a diagnosis of panic disorder. Other syndromes like obsessive compulsive disorder or post traumatic stress disorder can also cause agoraphobia, basically any irrational fear that keeps one from going outside can cause the syndrome.
It is not uncommon for agoraphobics to also suffer from temporary separation anxiety disorder when certain other individuals of the household depart from the residence temporarily, such as a parent or spouse, or when the agoraphobic is left home alone. Such temporary conditions can result in an increase in anxiety or a panic attack.
Another common associative disorder of agoraphobia is necrophobia, the fear of death. The anxiety level of agoraphobics often increases when dwelling upon the idea of eventually dying, which they consciously or unconsciously associate with being the ultimate separation from their mortal emotional comfort and safety zones and loved ones, even for those who may otherwise spiritually believe in some form of divine afterlife existence.
Agoraphobia occurs about twice as commonly among women as it does in men. The gender difference may be attributable to several factors: social-cultural traditions that encourage, or permit, the greater expression of avoidant coping strategies by women (including dependent and helpless behaviors); women perhaps being more likely to seek help and therefore be diagnosed; men being more likely to abuse alcohol in reaction to anxiety and be diagnosed as an alcoholic. Research has not yet produced a single clear explanation for the gender difference in agoraphobia.
Causes and contributing factors
Although the exact causes of agoraphobia are currently unknown, some clinicians who have treated or attempted to treat agoraphobia offer plausible hypotheses. The condition has been linked to the presence of other anxiety disorders, a stressful environment or substance abuse. Chronic use of tranquilizers and sleeping pills such as benzodiazepines has been linked to onset of agoraphobia. In 10 patients who had developed agoraphobia during benzodiazepine dependence, symptoms abated within the first year of assisted withdrawal.
Research has uncovered a linkage between agoraphobia and difficulties with spatial orientation. Individuals without agoraphobia are able to maintain balance by combining information from their vestibular system, their visual system and their proprioceptive sense. A disproportionate number of agoraphobics have weak vestibular function and consequently rely more on visual or tactile signals. They may become disoriented when visual cues are sparse (as in wide open spaces) or overwhelming (as in crowds). Likewise, they may be confused by sloping or irregular surfaces. In a virtual reality study, agoraphobics showed impaired processing of changing audiovisual data in comparison with healthy subjects.Learn More
In psychiatry, adjustment disorder (AD) is a psychological response to an identifiable stressor or group of stressors that cause(s) significant emotional or behavioral symptoms that do not meet criteria for anxiety disorder, PTSD, or acute stress disorder. The condition is different from anxiety disorder, which lacks the presence of a stressor, or post-traumatic stress disorder and acute stress disorder, which usually are associated with a more intense stressor. There are nine different types of adjustment disorders listed in the DSM-III-R. In DSM-IV, adjustment disorder was reduced to six types, classified by their clinical features. Adjustment disorder may also be acute or chronic, depending on whether it lasts more or less than six months. Diagnosis of adjustment disorder is quite common; there is an estimated incidence of 5-21% among psychiatric consultation services for adults. Adult women are diagnosed twice as often as are adult men, but among children and adolescents, girls and boys are equally likely to receive this diagnosis. Adjustment disorder was introduced into the psychiatric classification systems almost 30 years ago, but the concept was recognized for many years before that.
Disorders in this Category
- Adjustment Disorder Unspecified
- Adjustment Disorder with Anxiety
- Adjustment Disorder with Depressed Mood
- Adjustment Disorder with Disturbance of Conduct
- Adjustment Disorder with Mixed Anxiety and Depressed Mood
- Adjustment Disorder with Mixed Disturbance of Emotions and Conduct